Monday, December 19, 2005

Alicia Journal 1

My first week in clinic went more smoothly than I expected. It was a little overwhelming at first- all those mothers and their babies and their rapid-fire Spanish (and the fact that they seem to talk faster when we didn’t understand what they said the first time), the crazy multitude of names (and spellings) on all the charts, Global Healing volunteers coming in and out to use the phone and computer, hospital employees looking for Dr. Charles and the attendings, Dr. Charles’ illegible handwriting- but once I got used to the way things worked, it wasn’t all that bad. I already sort of knew some local medical terminology- like “calentura” for fever- after going with Audra to Peggy’s clinic the week before to help teach the weekly class for the Community Health Promoters Project in La Colonia. The week’s topic was diarrhea and respiratory illnesses and it was a good introduction to a lot of the common complaints I would be seeing in the clinic, as well as how they are approached medically on the island. Audra is making a lot of progress on the project with the volunteers and made sure to introduce me to Dr. Raymond and Peggy while I was there.
During our days of overlap while Ilena and I were waiting for the doctors to finish with their patients so we could enter their data, Ilena we through some of the books in the clinic’s “library,” including a book on Parasites and “Pediatric Dermatology.” I am convinced I am going to get scabies. No, seriously. I even had a dream about getting back to the States with scabies. Almost all the kids that first week had them. I’m sure it also helped that Dr. Charles showed me the rather large, cartoonish drawing of scabies that he points out to mothers to scare them into taking scabies seriously and making sure they treat their kids for it. Those bugs look like no fun. Ilena finds my paranoia incredibly amusing and proceeds to diagnose every bump and bite on my body as scabies. So much intern love.

When I first got here, Audra and Ilena were both sick with some kind of cold and sinus infection combo so we spent most nights that week indoors, watching “Desperate Housewives” Season 1 DVDs I had brought with me. Then it started raining for a week straight because of Hurricane Gamma so we stayed inside most of those nights, too. After that, it had become tradition. We mixed it up with some episodes of “House, MD” and “Grey’s Anatomy” that I had on my computer. “House” is especially great when we get to see some of the tropical diseases in clinic that they mention on the show. Like leishmaniasis. Fun! And “Grey’s” is about surgical interns at a hospital in Seattle so there’s lots of quotable goodness like, “You’re interns, grunts, nobodies, bottom of the food chain. Take orders, work every second of your life until you drop and don’t complain.” Yay intern abuse!

Eileen, the new attending and my roommate, arrived my second week in clinic. I think it is her 5th time volunteering on the island and in the clinic, so random people drop by all day to come and see her. Dr. Thomas, the resident from Chicago has really been enjoying some of the differences from back home. Last week, a mom came in with her daughter who had fallen out of a tree. He sent her to have an X-ray of her shoulder and she came back a few hours later holding a sopping wet x-ray of her daughter’s broken clavicle. Dr. Thomas kind of stared at it blankly like he didn’t know what to do with it.
“It’s wet,” he said. “It must have just been developed a few minutes ago,” he said more excitedly.
“Yeah, that’s what it looks like,” I said.
“That’s crazy!” he said then proceeded to clutch the x-ray for the next few minutes, not wanting to set it down and get everything all wet with x-ray developer or whatever liquid they dunk them in. I guess sometimes it’s just the little things.

Thanksgiving Day. Although I’d usually spend it scarfing down turkey and cranberry sauce at home, today was just not a good day for West End residents looking for a traditional American Thanksgiving meal. Fosters, the one restaurant that advertised an all-day Turkey Buffet, ran out of food before 4 pm. Drs. Eileen and Thomas, Nora, Ilena and I ended up eating rotisserie chicken- which is kind of like turkey, if you squint really hard- and a few days later I found a can of cranberry sauce at Warren’s (yes!).

I’ve gotten to see parts of the island I hadn’t really expected to from my crazy cab rides back from clinic. Somehow the cab drivers have all conspired to kill me. One time Ilena and I were nearly backed into by a truck and nearly ran off the road multiple times as the driver took the turns at 60 miles an hour. Not to mention the numerous bikers and pedestrians he nearly clipped. I was pretty sure that we weren’t going to make it. For the rest of the day after miraculously making it home alive, the colors seemed a little brighter, food tasted a little better. Nothing like a near-death experience to perk your day right up. Then there was just this ridiculous driver that detoured into La Colonia on the way back during the worst of the Gamma rains. We got about halfway up the hill when the car lost traction and started sliding backwards down the clay. He started cursing and thankfully abandoned the endeavor, managing to steer us backward down the hill to safety. Now you’d think after risking my life on this La Colonia adventure, the cab driver would be courteous enough to at least take me back to Casa Calico…but no. I was promptly ejected from the cab at the West End turn-around, left to trudge back home in a bonafide tropical storm. Funnily enough, while most cabs won’t think twice about going up the perilous, death-trap road to La Colonia, they refuse to go the last few feet to Casa Calico because “the road is too bad.” Craziness.
Then there are the random intense conversations I have with the drivers. One time I talked with this guy about how the island needs to invest more in the youth to keep them from getting into trouble and having problems as adults. He wanted to start a youth rehabilitation center on the island, which I thought was an interesting idea. Then he proceeded to talk to me about the importance of having Jesus in my life for the rest of the drive. Another time the driver launched into his whole life story, about how his daughter was killed when she was 10 and his wife left him and went to the mainland soon after. It was sad. And awkward. Apparently I am the only one blessed with all these taxi cab experiences as Audra and Ilena laugh at me every time I come home with a new one.

Last week Eileen was pretty sick with some stomach virus and Dr. Charles was on vacation so it was just me and Thomas in the clinic. Of there were more patients waiting to be seen on the day with only one doctor than I had seen on any other day thus far. It was ridiculously busy, but after I’d gotten through triaging everyone and was waiting for Thomas to finish with charts I did get to enjoy a warm and fuzzy moment with a little girl whose brother was being seen. I had changed the wallpaper on the computer earlier that week to fish and I guess she must have been in earlier because even though I had the spreadsheet open and you couldn’t see the desktop, the girl ran up and pointed to the screen and said “pescados.” When I minimized the window so the fish magically appeared she grinned and exclaimed, “there they are!” (in spanish of course) She then demanded that I put up a dog. Little did I know that by complying with her I request I would spend the next 10 minutes cycling through every wallpaper image that comes with Windows XP. When those were exhausted we started flipping through a picture book. It was in English, but no matter. Instead we went to work identifying the animals, doing pretty well between the two of us until we came upon a Hippopotamus. Neither of us knew the name in Spanish, but she was pretty amused when I explained how we say it in English. Then we moved on to colors, which was an interesting exercise as she knew the names of various colors, but apparently hadn’t learned to match them up with their respective shades. It was fun though, since we’d been so busy I hadn’t been able to spend much time talking to any one child.

In more recent news, Ilena, Audra, and I started our dive classes and went out on our 3rd open water dive today. The three of us were waiting about 15-20 feet down from the surface while the instructor was working on a skill with another guy. Out of nowhere this rather large fish swims straight at us and starts rubbing against our fins and legs. This wouldn’t have been problematic until it started heading towards my face and bared it’s evil little fish fangs. Let me explain that is was no ordinary fish. Despite what modern medical science may say to the contrary, it was clear that this fish had leprosy. It’s scales were flaking off in patches and it had sickly discolored splotches all over it. We’d had just about enough of leper fish when the instructor came back down and shoo-ed him away. She later informed us that it was a Dog Snapper trying to pass a leechy parasite fish to us, but he will always be Leper Fish to me.

Sunday, December 18, 2005

Ilena Journal 4

On the first solidly sunny day in a week and a half, I am genuinely coming down with a cold. Last week, I could practically feel the little kid germs crawling on my skin. Everyone came in sneezing and coughing. “If nothing else does, this will get me sick,” I kept thinking to myself. Although I tried to deny I was coming down with something over the weekend, this morning I woke up feeling gross. Though I expected today’s efforts to climb over the Insurmountable Language Barrier to be more easily rebuffed than usual today, I found that having a cold makes it a lot easier to blur the distinction between my Spanish “b”s and “v”s, which I can pretty much never do while healthy.

Along with the cold germs that seem to have taken up residence in my sinuses, making my head feel like it’s being squeezed in a vice, several new tropical friends have suddenly moved into the bathroom. We’ve now got a large (“It’s not that big,” says Audra) mini-tarantula-esque spider and some kind of small lizard that settled in the shower.
We also have a new intern. And a new attending.

With Alicia here we’ve got a triad of names bookended by “a” sounds and the beginning of some kind of joke: Audra, Alicia and Ilena walk into a bar... Alicia brought two crucial things (in addition to her lovely self): DVDs (particularly season 1 of “Desperate Housewives”) and the news that iTunes is selling current episodes of “LOST” (an incurable addiction of mine).
Stephanie discovered another hospital absurdity to add to the list: an X-ray of a pregnant woman, hanging on the wall in the labor and delivery room. As there are no ultrasound machines here, to conclusively determine the position of an unborn baby x-rays are the only resource available.

Clinic was eerily quiet the past week. Only a handful of children showed up each day, along with a tall Cuban doctor who comes in to use our internet and asks me questions (en espanol) about navigating yahoo mail. Hep A kid came back and looks much improved; where before there was a completely lifeless-looking child there is now a kid that looks healthy. I’m glad his illness has turned around. Sadly, we also made him and his mom come back, twice, as they were unable to get the lab test done yesterday and we were unable to wait for the results expected at noon this afternoon (considering we closed up shop at 10:30).

On Alicia’s first day in the clinic, everything went smoothly, despite one little girl throwing a tantrum and nearly hitting Alicia in the face. Hep A kid was finally seen and has continued to improve.

Two days later we were greeted in the morning by a hallway full of people and 30 charts. Alicia and I divided our triage duties in half, sharing access to the scale and the growth charts and trying to dodge the half-dozen random people who kept appearing and complicating an already overwhelming process. First the Cuban doctor whose been using our internet, then a nurse with two women and a newborn in tow (who claimed there were here because the baby had a fever – but it was normal when we took the temperature) who disappeared shortly afterwards, then the pharmacist, looking for a file Nora had left on the computer (which was supposedly in Spanish although we couldn’t find it) who returned later (at possibly the most inconvenient moment of all, when Alicia and I had five kids between us that we were trying to juggle) with Nora in tow, Dr. Green for a short time and finally an absolute parade of crazy mothers. One woman kept insisting that she was third in line, though I had found her chart at the bottom of the pile. Another mother showed up with her kids in tow but with no charts, asking for a doctor to read her lab results; Dr. Charles read her the riot act but saw the kids anyway and ended up sending the family to Valerie’s to get the youngest, suffering from a completely hacking cough, a third HIV test. A family of three came in and the middle child, a girl, began almost silently throwing up a stream of bright orange vomit into our wastebasket. I felt both sorry for the girl and grateful for her neatness and discretion.

After our take-no-prisoners triage efforts, Alicia and I finished early and read up on parasites, infectious diseases, pediatric dermatology and Global Healing’s advice and protocols while kids were crying and vomiting all around us. Charles had given Alicia one of the greenish yellow “oranges” they sell outside the hospital; one little boy started chattering away at us, asked for our orange and proceeded to start hiding it in his baseball cap while coming in and out of our area. He was obviously bright and completely adorable. Despite some of the craziness that occurs daily, working here has its rewards.

Ilena Journal 3

Clinic got off to a late start this week. Lucky for all of us, Leonel decided to stick around for a few days, he came into clinic to show the new attending the ropes. The way things were supposed to work out originally was that the new attending would start working in the clinic basically without knowing the hospital’s system or the hospital at all since there was no overlap between attendings. With Leonel around the transition was much smoother.

Tuesday, Dr. Stephanie, the new attending, called me out of the clinic to come see “something interesting.” With more than a little trepidation I followed her down the long corridor into another clinic where a girl of about eight was sitting with a giant, weeping ulcerated wound just above her ankle. Leishmaniasis, they said. Carried by fleas, this parasite eats away at the skin, but causes no pain. Although the girl had the cutaneous form, there are visceral and other forms of leishmaniasis that can cause deformities and other ailments. This girl’s lesion had been steadily growing for four months; tests had been done that confirmed the presence of the parasite and a secondary infection. Apparently it’s not endemic to this area, she had been bit on the mainland and brought the parasites with her (one doc mentioned that other fleas may bite her now, becoming vectors that could infect other people with the parasite).

When I returned to clinic there were a string of run-of-the-mill complaints- colds, constipation, 10 day old babies in for well visits, followed by two seven year old boys with unusual pathologies- one’s yellow eyes, upper right quadrant tenderness and inability to eat suggested Hepatitis A, a disease that, Leonel said, many American pediatricians have never seen. (After calling me in to take a look, he asked, “By the way, have you been vaccinated against Hep A?” I told him I had received the first of the two inoculations. “Oh” he said, pausing, “You may want to take a step back, then.”)

The second boy’s story came out a bit muddled: He had been tooling around with a screwdriver and either scratched his eye with it or was around his father while his father scraped paint off the walls and managed to get some of that in his eye. In any case, the eye was inflamed and Leonel was concerned he may have scratched his cornea. Charles caught that it was actually a relatively large ulcer at the top of the eye. We had to look at the eye as if it were a hologram, adjusting the kid’s head and our perspective to get the light to hit the surface of the eye at just the right angle to see the ulcer, a cloudy triangle.

We rented “Dear Frankie,” a movie about a scrappy but damaged Scottish boy and his scrappy but damaged mom, and watched it on my computer, using the speakers Leonel had bought. In the middle of the movie, Leonel got up abruptly to check something out on the floor. He said there was a frog in the apartment, that he had seen it hopping. Audra and I were surprised- how did a frog climb all those stairs? We went back to watching the movie. Afterwards, as we were cleaning up the hot chocolate mugs and putting the chairs back, I said I hoped the frog found its way back out and Leonel confessed it wasn’t a frog he had seen. “Cockroach?” I asked. He reluctantly said yes. Regardless of whether he lied for my peace of mind or because he thought I would flip out and disrupt the movie, I appreciated the gesture. Things are going to be different when he leaves.

Later this week there was a mayonnaise jar with a cancerous uterus floating inside it that is perched on the orderlies’ desk in the maternity ward. It sat above the charts for the newborns that lie side by side, waiting to be read through and signed by the attending. It looks more like a naked, twisted cassava root than a womb. Apparently, as someone randomly came in and told us in clinic, it and the woman it was once a part of are wanted in pathology. I also saw my first instance of soda in a baby’s bottle. I had been on the look-out for it since Audra had mentioned it was common practice but this was my first real sighting. There really is no question why half the children who come through the clinic have brown teeth rotting slowly in their gums.

As part of her introduction to the clinic, we took Dr. Stephanie to the “country bar” in Coxen Hole, one of Dr. Charles’ favorite haunts. A piece of cardboard taped up above the women’s toilet reads, “VORNING,” then a little space before the line, “Don’t do no dope in the toilet.” Then it said the same thing again, slightly more formally, in Spanish.
For all the tearing asunder from their rightful places that goes on in the hospital of organs, food and waste products, there was one reunion story this week. When I first came to the clinic, Leonel, in his infinite optimism, taped up the vaccination record card that Jennifer Suoza Flores had left behind. “She might come back for it someday,” he said. For weeks it sat square in the middle of my field of vision when I looked just above the computer monitor. Then finally, I go to call the next patient in for triaging and who was it but Jennifer Suoza Flores herself. If this were a made-for-tv movie, my handing back the scrap of paper would have been in slow-motion, with grandiose music in the background.

Things growing where they shouldn’t seemed to be the theme of the day: one case of hair fungus, where a young boy of seven had a huge round bald spot towards the back of the right side of his head, and of course the usual parade of worms and intestinal parasites although made more noteworthy this time by one of the mothers saying that although she hadn’t noticed anything abnormal in her kid’s stool, they had traveled north instead of south; he had been chewing on ascaris worms the night before. In addition, the past two days have featured several repeat customers. Hep A kid came back, looking healthier and the probable malaria twins returned, too, although only one of the almost identically named identical twins’ malaria smears came back positive. But malaria tests are like fishing; you keep casting your line out until you reel in the result you want.

Ilena Journal 2


The roach has been vanquished. Nurse Audra, the newest addition to the team (and also my new roommate) cornered and killed it after I saw it flying around the room. Who knew that cockroaches could actually fly? I thought they were like turkeys or ostriches- winged but only decoratively. That cockroach zooming across the room today will definitely haunt my nightmares for a long time to come.

Other than that, clinic was absolute chaos today. Children everywhere, parents suddenly appearing in the doorway demanding that their kids be seen, the odd Global Healing staffer showing up to use the printer and complain about our/the island’s/the country’s lack of resources. Two kids came in with sebarrheic dermatitis and one who potentially had diabetes insipidus, a condition where you’re constantly creating urine and are unable to control its flow. Nurse Audra, who works in obstetrics, told me about a pregnant woman who had the same condition who put out a liter of urine while trying to deliver her child and then another liter immediately after the C-section; it’s a condition that can easily lead to dehydration and other problems but can be ameliorated with medication. The kid in our clinic was thirteen and had been wetting the bed every night for the past five years. He’s definitely won the prize for oldest patient I’ve seen so far and had the most unique pathology of the day. Lucky kid.

Audra also helped manage the flow of charts between me and the doctors so that there is a more efficient and less confusing system. She reorganized the shelves and has a few more clinic improvement ideas she’ll be putting into place. I put the invaluable (yes, that was sarcasm) skills I learned while temping to use in putting file folders in the drawer in place of the stack of manila folders laying there haphazardly. Hopefully I’ll come up with some kind of systematic way of dealing with the random scraps of paper that have been accumulated and that no one seems to use.

After clinic I headed over to Miss Peggy’s clinic to learn about The Project (capital T capital P) and how I can pick up where Jess left off. Unfortunately, Matt and Miss Peggy had forgotten I was coming and Matt- who I guess was supposed to show me the ropes- was in West Bay. We decided to talk again tomorrow when Miss Peggy and her entourage come to the hospital.

On the non-business end of things, I got to go swimming for the first time in a week and then had my first shower with a continuous stream of hot water. Reena, Audra and I made a pot-luck style dinner- including the newest menu item I have in my arsenal of culinary catastrophes/experiments: eggplant with black beans and onion- then got dessert at the Argentinean restaurant with Leonel and his three friends from home who are visiting for the week.


Nothing super-exciting in clinic today but everything seemed to go so slowly. Part of this was due to the nearly constant stream of non-patients that came in and out, including Nurse Peggy and her crew. Nurse Peggy’s resident, Matt, briefed me on The Project that Jess was involved in and that I hope to do something with. The only trick is, the way things progress here, the turnover of the people involved and the current unavailability of internet just about everywhere on the island, there aren’t concrete dates set for Project meetings. So I volunteered to hunt down internet access and obtain information on diabetes and hypertension for the community health initiative in Flowers Bay.

Nurse Audra continued her streak of resourcefulness and ingenuity. I thought the baby scale had miraculously fixed itself when it was no longer registered 1 lb of weight when nothing was resting on it. When I announced to the room the magical self-correcting abilities of our scale, Audra told me she had calibrated it with a dial on the back. That one had stumped the docs for weeks. She even managed to make friends with someone who works in the hospital with the willingness and the resources to make a curtain for the window in the clinic’s door. Now, hopefully, people won’t keep just barging in. Like I said before- lots of optimists in this crowd.

Lack of internet is beginning to frustrate me. I have no idea what’s going on in the world beyond Roatan and have lost touch with everyone back home. My family has given me up for dead. Audra and I were talking about The State of American Politics while sitting in our newly cleaned living room today and I tried to make a point about Harriet Miers, then realized that I had no idea whether she was confirmed to the Supreme Court or where that whole issue stood. I would do a lot for steady access to CNN right now.

Tonight was Night of the Burning Basura. All throughout the island a thin glaze of smoke hung in the air from people burning leaves and other detritus that Wilma left in her wake. Apparently since it’s the first clear night since the hurricane, without wind, everyone decided it was time to start fires.


Three interesting things in clinic today- first some good news: gastroschisis baby went home after only five or so days in the hospital. Second, a girl with abnormal bone growth in her legs. Rodney said it may be rickets- a lack of vitamin D- or childhood rheumatoid arthritis. Third, a baby with a cough, whose mom had a cough that had lasted a year, including coughing up blood the past two weeks. On top of this, they lived with the mom’s grandfather, who had been diagnosed with tuberculosis. The docs didn’t think the baby had TB but they got the mom into the system to be monitored/treated.

The biggest news of all- Casa Calico now has internet! I’m absurdly happy about this. Here’s hoping it will last.

Thursday and beyond

Today was Reena, Rodney and Leonel’s last full day on the island. It’s going to be very quiet around here after they take off tomorrow morning. The basic plan for the day was to rent cars and travel around to the far-away parts of the island. Although the steep rental fee (we ended up paying 70 dollars each for two Jeep Wranglers, although they initially charged 85, plus gas) would have been prohibitive for a smaller group, three of Leonel’s friends from home were visiting this week and helped offset the cost. We drove past Coxen Hole, through Los Fuertes, past Jonesville and into Oak Ridge. Driving around today opened my eyes to the places where the people who come into clinic are coming from; before they were just names to me.

In Oak Ridge we traveled through the mangrove tunnels, in the slowest speedboat on the island. Pirates carved out the tunnels (although our guide didn’t think so), using them to hide from law enforcement. Before we went exploring, however, we had to get the car to start.
“Don’t worry,” Leonel said, “It did this the last time I rented it, too.” (Yes, everyone’s favorite sentimentalist knowingly rented a broken car).
It took a handful of the dozen taxi drivers waiting by the dock to push the car downhill, open the hood and bang on the parts, then push the car back up the hill and repeat the whole process. It was comical, especially when the car started (rather than the alternate ending of having to get it towed).

Two of Leonel’s friends, Nora and this girl one of Leonel’s friends had met all went to Camp Bay Beach in lieu of joining us in among the mangroves. After we piled back into the Land Rover, we took off in pursuit of them. We passed each other as they were coming back towards the main road from the beach; a storm was coming, they said, and they were advised to get to the road. Naturally, we kept going towards the beach, determined to see it quickly then be on our way. Leonel planned to keep the car running while we were there, just to make sure we weren’t stranded. There was no one else around but he got paranoid about leaving the keys in the ignition without someone standing by the car and decided to shut it off. The beach was pretty and completely deserted, but the waves were growing, the sky looked like it was about to storm any second and the water was coming far up the beach. After five or so minutes, we decided to be on our way. The car had other plans. The engine would not engage. We began to push it towards the road, periodically attempting to start it and trying not to get too worried about the situation. Luckily, after a few minutes, the car started, we all jumped in and roared off.

The next day, Hurricane Beta, our newest friendly neighborhood weather disaster, had been pummeling Nicaragua and wanted to visit Honduras but changed its mind at the last moment. Instead, it has sent its emissaries- heavy rain, high-speed winds- our way. As a result, Audra and I spent the entire day inside, reading and listening to her ipod. Leonel’s friends and Reena successfully left Roatan, Rodney and Leonel- who were supposed to take the oversized model airplanes that fly out of the airport into San Pedro Sula and El Salvador respectively- proved not as good at being gone. Rodney was told flights were taking off tomorrow but Leonel decided to stay until Thursday, eliminating my need to say anything nice about him in this journal entry.